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Assistance:Information & Online Intake form

Assitance

Starting in July 2000, Iowa Protection & Advocacy embarked on a new pathway to handle intakes within our agency.
Intakes are the letters, phone calls, and visits we get from the disability community who need assistance, have
questions, or are wanting referrals to organizations more appropriate to meet their immediate concerns.

Intakes are a BIG part of our system! The new procedure was developed because the Board and Staff saw a need
for improvement in serving Iowans with disabilities. In the few months we have been using this newly refined approach,
we have served twice as many individuals than we did in the first six months of the calendar year. Here's how our
new intake procedure works:

When an individual contacts our office for help, advice, or information concerning disability-related issues, they
are first asked by our receptionist for basic information such as name, address, phone number, age, and a brief
description of their concern. After obtaining this information, the receptionist directs the person, as well as their
information, to one of the advocates on the Core Services team.

These advocates carefully listen to the person in order to determine how best we can serve them. Contrary to
the intake operation in the past, when people call the agency today with issues and concerns, they will not always
be talking with the same advocate. Many experienced people work together on the Core Services team to provide
the best possible advocacy.

Advocacy within Core Services may fall into one of a couple different areas. At the heart of any P&A is Information/Referral
and Short-Term Advocacy on non-priority issues. Information/Referral is just that: information on a question and referral to
an organization specializing in the problem where further advocacy is necessary. Per our mandate, any advocacy over one
hour is considered Short-Term Advocacy and may involve agency intervention which lasts from one hour up to 30 days,
again, on all non-priority issues.

Priority issues, however, are the soul of every P&A organization and are handled as such. Rather than remaining in
Core Services for any period of time, all priority issues go immediately to Priority Service teams for direct case advocacy.

With this new procedure, we are now serving Iowans with disabilities faster, with greater ability and with better advocacy.
We know with Core Services in place that we can make ourselves more accessible to Iowans.

Online Intake Form

DATE: TIME: AM/PM

CALLER/CLIENT
FIRST NAME: LAST NAME:

PHONE: ALTERNATE PHONE #

PERMISSION TO LEAVE MESSAGE: YES NO

ORGANIZATION:

RELATIONSHIP WITH CLIENT:

ADDRESS 1:

ADDRESS 2:

CITY: STATE: IA ZIP:

COUNTY:

GUARDIANSHIP:

CLIENT INFORMATION
FIRST NAME: LAST NAME:

PRIMARY DIAGNOSIS: DATE OF DIAGNOSIS:

Phone Number:

Alternative Phone Number:

ADDRESS 1:

ADDRESS 2:

CITY: STATE: IA ZIP:

COUNTY: DATE OF BIRTH: / /

GENDER: M F LANGUAGE: RACE: EDUCATION:

IS ANOTHER AGENCY HELPING YOU W/THIS ISSUE? NO/YES-NAME OF AGENCY:
IS THERE AN ATTORNEY INVOLVED WITH THIS ISSUE? NO/YES-CONTACT NAME

Is your Attorney representing you on this issue/or concern that you are calling IP&A about?

IS THERE A DEADLINE WITH THIS ISSUE?

PROBLEM/CONCERN: CIRCLE ONE PRIMARY CONCERN: ABUSE/NEGLECT HEALTH FINANCIAL
HOUSING EDUCATION EMPLOYMENT TRANSPORTATION SSI/SSDI

If "OTHER" explain briefly:

Tel: (515) 278-2502 Toll Free (800) 779-2502 Fax: (515) 278-0539 TTY: (515) 278-0571
TTY Toll Free: (866) 483-3342
Location: 950 Office Park Rd., Suite 221, West Des Moines, Iowa 50265 Email: info@ipna.org [ map]
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